Self-Pay With Medicaid insurance question

I have a very rare medical condition where only two doctors in the country offer treatment. I have Medicaid but the healthcare facility that offers treatment is out of state and isn’t in network with/doesn’t accept out of state Medicaid. So I had to self pay in advance $4,500 (cost estimate). I’ve had this procedure once in the past and adjustments were made where I received an $1,800 refund. All charges for this appointment are the same. But no adjustments have been made. I contacted billing who responded they’re waiting to hear from insurance.

But I had to agree to self-pay as they don’t accept my insurance. Pay a cost estimate in advance. Medicaid laws confuse me. So my questions are:

If a hospital doesn’t accept out of state Medicaid —Are they required to charge the same amount they’d charge in state Medicaid? (This was a procedure not emergency care)

Or were the adjustments to my bill the first time maybe made because they discount self pay patients in general?

I’ve contacted so much and just can’t seem to get answers. It’s been really difficult. I’d appreciate input from anyone who understands medical billing laws and such.

submitted by /u/No_Security4259
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